Medicare Prescription Drug Improvement and Modernization Act of 2003
Questions about Medicare reform? This link to www.medicare.gov provides you with access to the most current information regarding the Medicare Prescription Drug Improvement and Modernization Act of 2003 that you will need to help make the best decisions regarding your Medicare coverage. Go now
Prescription Drug and Other Assistance Programs
Welcome to the Prescription Drug and Other Assistance Programs section of www.Medicare.gov. This section provides information on public and private programs that offer discounted or free medication, programs that provide help with other health care costs, and Medicare health plans that include prescription coverage. It also provides information on even more ways you can reduce your prescription drug costs, such as by using generic alternatives. Go now
Facts About Upcoming New Benefits in Medicare
Q: What are a beneficiary's rights under Medicare?
A: You have certain rights under Medicare, whether you're enrolled in the Original Medicare Plan or another Medicare health plan. These rights include the following:
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The right to protection from unfair practices in marketing and enrollment.
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The right to information about what is covered under Medicare and what you are obligated to pay.
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The right to accurate and timely information about all treatment options available to you.
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The right to appeal decisions that have been denied to you or limited payment for medical care.
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The right to know how your doctors are paid under your Medicare plan.
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If appropriate, the right to choose a women's health specialist.
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The right to receive a treatment plan that includes direct access to a specialist if you have a complex or serious medical condition.
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The right to receive emergency medical care.
Q: How do I reach Ohio KePRO's Medicare Beneficiary Helpline?
A: The Helpline can be reached toll-free by calling 1-800-589-7337. The Helpline operates from 8:00 a.m. to 4:30 p.m. Monday through Friday. At other times, beneficiaries, or their family members, can leave a message on Ohio KePRO's voice mail. Calls will be returned on the next working day.
Q: I'm 85-years-old and am in the hospital. The hospital wants to discharge me. However, I don't think I'm medically ready to be discharged. What should I do?
A: Immediately, ask a hospital representative for a written notice of why they want to discharge you, if you have not already received one. This notice is called a Hospital Issued Notice of Noncoverage (HINN). You must have this notice if you wish to exercise your right to request a review of your case by Ohio KePRO.
Once you have received the notice in writing, you must make your request for review of your case to Ohio KePRO by noon of the first working day following the receipt of the notice by contacting Ohio KePRO by phone (1-800-589-7337) or in writing.
Ohio KePRO will complete the review of your case within 3 working days. You will be permitted to stay in the hospital (Medicare will pay for this stay) while Ohio KePRO conducts its review. If Ohio KePRO's review determines that you still require inpatient care, you are permitted to stay in the hospital and Medicare will continue to cover your admission.
If Ohio KePRO determines that you no longer require inpatient care and you decide to stay in the hospital, you will become liable for the cost of the care at noon of the day following Ohio KePRO notifying you of its decision. If you decide to leave by noon of the day following Ohio KePRO notifying you of their decision, Medicare will pay for your admission.
If Ohio KePRO determines that you no longer require inpatient care and you disagree, you can ask for a reconsideration of its decision. In this case you will need to notify Ohio KePRO by noon of the first working day following the receipt of the notice by contacting Ohio KePRO by phone (1-800-589-7337) or in writing that you would like a reconsideration.
As a result of its reconsideration, Ohio KePRO may reaffirm or reverse its prior denial determination. If it reaffirms the denial determination, you will continue to be responsible for payment of services furnished as of noon of the day following the notice of Ohio KePRO's initial denial determination. If it reverses the denial determination, you will be refunded any amount collected by the hospital except for payment of deductible, coinsurance, or any convenience services or items normally not covered by Medicare.
Q: I've been hearing a lot in the news recently about Medicare coverage for prescription drugs. Does Medicare pay for outpatient prescription drugs?
A: The Original Medicare Plan does not cover outpatient prescription drugs except in a few instances, such as for certain cancer drugs. However, many managed care plans cover outpatient prescription drugs, up to certain limits. Some Medigap policies also cover certain outpatient prescription drugs. A Medigap policy fills gaps in Original Medicare Plan Coverage. Medigap insurance must follow federal and state laws. All Medigap policies are clearly marked "Medicare Supplemental Insurance." You are quite correct about this issue being in the news. There are several proposals being discussed in Congress and at the White House that would provide prescription drug coverage for Medicare beneficiaries. We will continue to carefully monitor this situation and report any developments on this web site and in Ohio KePRO's Medicare beneficiary newsletter, "For Your Benefit."
Q: I lost my Medicare card. How do I obtain a replacement?
A: Please call the Social Security Administration at
1-800-772-1213.
Q: I'm 70-years-old and want to get a mammogram. Is this covered by Medicare?
A: Yes. All female Medicare beneficiaries age 40 and older are covered by Medicare for one screening mammogram every 12 months. The beneficiary pays 20% of the Medicare approved amount with no Part B deductible. Medicare does not require a physician referral for a mammogram.
Q: My doctor recommends that I get a flu shot. Is this covered by Medicare?
A: Medicare pays for a flu shot each year for all Medicare beneficiaries. Medicare also pays for a single pneumonia shot, which you get after you turn 65. Hepatitis B vaccination will be covered for those at high or intermediate risk for hepatitis. No coinsurance and no Part B deductible is required for flu or pneumococcal vaccinations. For the Hepatitis B vaccination, you are required to pay 20% of the Medicare approved amount after the Part B deductible. The amount Medicare approves (the Medicare approved amount) is what Medicare will pay for a certain service or supply.
Q: Will Medicare provide coverage for the monitoring of my diabetes?
A: All Medicare beneficiaries with diabetes (insulin users and non-users) are covered. This includes coverage for glucose monitors, test strips, lancets, and self-management training. Beneficiaries pay 20% of the Medicare approved amount after the annual Part B deductible. A deductible is the amount you must pay for health care, before Medicare begins to pay. There is a deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.
Q: I have a question about my bill. Who do I contact?
A: For questions about a hospital bills and services, please call the Fiscal Intermediary at 1-513-852-4314. For questions about Part B bills and services, please call 1-800-282-0530.
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